Why are some people fine with disc bulges and others have constant, gripping, neuralgic type pain? Aside from everything I’ve said about how pain and the brain work, it’s important to recognise that if a spinal nerve is physically irritated, this can push you into a whole different domain. As was explained to one of my patients by her orthopaedic surgeon, it depends on the size of the bulge, the size of the nerve and the size of the space the nerve normally occupies.
Small prolapse, small nerve, big space means potentially no pain, or mild transient pain. But, big prolapse, big nerve, small space may mean a big pain.
Some people are prone to disc prolapses – a bit like heart disease can run in families, so can disc problems. I have seen a few patients who have had more than 3 disc prolapses, and most of them have relatives who are in the same boat. It’s almost certain that you just have poor discs, and that this predisposes you to tears. All the advice here still applies – you’re just starting further down the cliff.
Bearing load in the most spine-sparing way possible is vitally important for someone with disc problems. If you’re lucky enough to improve, DON’T take it for granted. If one disc has gone wrong, there’s a greater chance that another one could follow (or the same one again). Follow all the advice around peak, cumulative and sustained load and make sure you are picking out as many preventers as possible.
Lots of people around you won’t understand how bad this is, or what a life-changing effect it’s having on you. Don’t get mad at them – this will only make your situation worse. Focus on what’s right for you, and look for support from those who seem keen to give it. You will tire quickly and can’t afford battles with people who just don’t get it. If your doctor isn’t sympathetic, find another one.
It’s often valuable to connect with others who have had similar problems; you may feel reassured to hear how they’ve overcome similar issues. Other sufferers can help with motivation – encouraging you when you need it most, and maybe commiserating when things are not going so well. But remember that your situation is unique – no one has experienced your back problem, only you. So sometimes you need to take their advice with a pinch of salt. Use the Cliff of Pain framework to stay focused on your own particular set of challenges.
Discs have no direct blood supply and so their nutrients come in slowly from the bones above and below. Any necessary healing will take considerably longer than in most tissues. Don’t expect a quick fix. But, again, if you follow the principles here you stand an excellent chance of getting better.
Nerves on the other hand do have a good blood supply. The problem with nerves is that, once irritated, they tend to stay at a high level of irritability for quite a while afterwards. If you’ve ever given your “funny bone” a really good bang, you’ll know that your forearm and hand can be not quite right for months afterwards – that’s because your funny bone is really your ulnar nerve passing round the back of the elbow. Once traumatised, it’s going to stay raw for a while.
So, discs and nerves can heal, but they take a good deal longer that other tissues.